Allergy and asthma proceedings最新文献

Background: The data on subphenotypes and treatment responses to biologicals in late-onset asthma (LOA) is limited. This study aims to compare the clinical characteristics and treatment responses in severe asthma patients receiving biological treatments, categorized into early-onset asthma (EOA) and LOA groups. Methods: Patients treated with omalizumab or mepolizumab for at least six months at a tertiary care adult allergy clinic between December 2015 and December 2023 were included. Patients with persistent respiratory symptoms starting at age ≥40 years were categorized as LOA, while those with onset <40 years were categorized as EOA. Changes in Asthma Control Questionnaire (ACQ-6) scores, forced expiratory volume in one second (FEV1) percentages, and blood eosinophil counts were assessed at baseline and 6 months. The percentage change in FEV1 (liters) at 6 months relative to baseline was measured. Clinical remission rates were evaluated in those completing one year of treatment. Results: Among 87 patients, 38 (43.7%) had LOA and 49 (56.3%) had EOA. Of these, 22 (25.3%) received omalizumab and 65 (74.7%) received mepolizumab, with a mean treatment duration of 24.7 (±19.7) months. LOA patients had higher obesity rates and tobacco consumption compared to EOA patients (p = 0.041 and p = 0.024, respectively). There were no significant differences between LOA and EOA groups in ACQ scores, FEV1 percentage, the percentage change in FEV1 in liters and eosinophil counts (p = 0.531, p = 0.219, p = 0.632, p = 0.700, respectively). Within LOA patients, ACQ scores did not significantly differ between those treated with omalizumab and mepolizumab (p = 0.801). At 6 months, eosinophil counts significantly decreased with mepolizumab but not with omalizumab (p = 0.002). Conclusion: Biological treatment responses were similar between LOA and EOA groups. Omalizumab and mepolizumab showed comparable efficacy, with the exception of eosinophil count changes in LOA patients.

Objective: To assess the association between airborne particulate matter (PM) exposure and the development of asthma in children, a systematic review and meta-analysis that included nearly 10 years of related literature was conducted. Study Design: The study investigators conducted a systematic review of relevant research articles published between March 2013 and March 2023, which were accessible through several medical literature data bases of. Random-effects meta-analyses were used to analyze the effects of PM on childhood asthma. Subgroup analyses, including exposure period, type of PM, regional factors, and study type, were also used. Odds ratio (OR) and 95% confidence intervals (CI) were used to represent the estimated effect of the population. Publication bias was assessed by using the Egger test and funnel plot. Data analyses were performed using statistical analysis software and a systematic review management tool. Results: A total of 15,365 articles were identified, of which 19 studies were included in this meta-analysis. The results showed that PM exposure was positively correlated with asthma in children, with the overall random-effects risk estimates of OR 1.10 (95% CI, 1.07-1.13). In stratified analyses, PM exposure was found to be a risk factor for the development of childhood asthma. Both prenatal and postnatal PM exposure were associated with an increased risk of asthma in children, but prenatal exposure was associated with a greater increase in risk than postnatal exposure, with an effect estimate OR of 1.21 (95% CI, 1.02-1.43). In the analysis of different PM types, the OR of PM_2.5 (PM < 2.5 μm in diameter) exposure was OR 1.10 (95% CI, 1.05-1.15), and no association was found between PM₁₀ (PM < 10 μm in diameter), coarse PM (PM with an aerodynamic diameter between 2.5 and 10 μm), and black carbon BC (diameter of 0.01-0.05 μm) exposure. In different regional analyses, the effects of PM exposure on childhood asthma risk were OR 1.15 (95% CI, 1.13-1.17) in South America and OR 1.02 (95% CI, 1.01-1.03) in Asia, but no association was found in Europe and North America. In addition, the results of different study types only found that the literature that used the time-series research method had a significant association with OR 1.03 (95% CI, 1.02-1.04), whereas the literature that used the cohort study method had no statistical difference. Conclusion: Exposure to airborne PM increased the risk of asthma in children. Both prenatal and postnatal PM exposure was associated with an increased risk of childhood asthma, but prenatal PM exposure was associated with a greater increase than postnatal PM exposure.

Background: In patients with asthma, bronchoconstriction and airway inflammation both contribute to airway narrowing and airflow limitations, which lead to symptoms and exacerbations. Short-acting β₂-agonist (SABA)-only rescue therapy addresses only bronchoconstriction and is associated with increased morbidity and mortality. Current asthma management guidelines recommend concomitant treatment of symptoms and inflammation with a fast-acting bronchodilator and inhaled corticosteroid (ICS) as rescue therapy for patients ≥12 years of age. However, there is an education and outreach gap for the wider adoption of anti-inflammatory rescue therapy in clinical practice. Objective: AstraZeneca has developed an education program for health-care practitioners (HCPs) based on a Knowledge-to-Action Framework, with the aim of increasing HCPs' understanding of key disease-state concepts related to evidence-based management of asthma. Methods: A multichannel, evidence-based education program was presented at medical conferences across the United States between December 2022 and December 2023. Before and after each event, attendees were asked to complete a survey that rated their agreement with six disease-state concepts on a five-point Likert scale. These concepts related to the role of airway inflammation, fluctuations in inflammation, SABA and ICS therapy, and the risk of exacerbations. Postevent responses to the survey were assessed relative to pre-event responses and longitudinally over 12 months by using calculated odds ratios and 95% confidence intervals. Acceptance and/or understanding of a concept was defined as a rating of "agree" or "strongly agree" from at least 80% of respondents. Results: The proportion of respondents who agreed or strongly agreed with each concept was significantly higher postevent versus pre-event (p < 0.001). The 80% acceptance and/or understanding threshold was surpassed for all concepts after the event. Conclusion: The medical education program improved understanding and/or acceptance of key disease-state concepts related to asthma management among participating HCPs. Effective communication of disease management concepts may lead to improved patient health outcomes through more rapid acceptance of guideline-recommended medical therapies.

Background: Eosinophilic esophagitis (EoE) is a disease characterized by eosinophilic inflammation of the esophagus and associated esophageal dysfunction with increasing worldwide prevalence. Clinical presentation is nonspecific and varies with age, with limited studies in the pediatric population. Objective: Our study aimed to compile clinical phenotypes, esophagogastroduodenoscopy findings, and treatment response of EoE in a tertiary pediatric center, and to examine factors associated with the response of treatment. Methods: In this retrospective study, we reviewed the medical records of 824 patients diagnosed with EoE at Children's Hospital of Michigan from 2011 to 2021. Data collected included a demographic profile, symptoms, esophagogastroduodenoscopic and histopathologic findings, treatment modalities, response, and compliance. We then performed a multivariable logistic regression to assess the associating factors that influenced the treatment response rate. Results: A high proportion of males and coexisting allergic conditions were observed in the patients with EoE, with the most common presentation of vomiting in children and of abdominal pain in adolescents. Among 656 of the 824 patients who had follow-up esophagogastroduodenoscopy, treatment response rates varied among modalities, with proton-pump inhibitor treatment exhibiting the highest response rate, at 60.8%, followed by diet modification (50%) and topical steroid treatment (43.5%). Significant predictors of normal endoscopic findings at follow-up included female gender, normal endoscopic appearance, good compliance to treatment, and absence of topical steroids in the treatment regimen. There were no significant differences in outcomes observed for targeted elimination led by a skin-prick test or specific immunoglobulin E test. Medication compliance did not significantly differ among the treatment options. Conclusion: Managing EoE in pediatric patients poses significant challenges, which emphasizes the need for multidisciplinary care to achieve treatment response effectively. The findings underscore the complexity of managing EoE and the need for individualized treatment approaches. Further research is warranted to elucidate the underlying mechanisms and optimize management strategies for pediatric patients with EoE.

Background: Although previous studies have confirmed that Janus kinase (JAK) inhibitors have good efficacy and safety in the treatment of atopic dermatitis, the U.S. Food and Drug Administration has issued a black box warning for all JAKs. Therefore, it is necessary for us to further pay attention to their safety. Method: The medical literature data bases were searched from database creation until August 26, 2023. Randomized controlled trials of moderate-to-severe atopic dermatitis treated with JAK1-selective inhibitors (upadacitinib and abrocitinib) were included. Results: In this meta-analysis, which included 12 studies (one of which reported two outcomes), we collected data at 2, 4, 8, 12, and 16 weeks. Almost all results showed that JAK1-selective inhibitors were more efficacious than controls and had an onset of action at week 2. There was no significant difference in the incidence of serious adverse events and adverse events, leading to discontinuation, whereas, for treatment-associated adverse events, the JAK1-selective inhibitors were higher than the control group (RR 1.16 [95% confidence interval, 1.11-1.21]; p < 0.00001). Conclusion: Overall, the treatment of atopic dermatitis with JAK1-selective inhibitors has a rapid onset of action. However, we need to be aware of the treatment-associated adverse events, more studies need to be conducted to provide better decisions on clinical medications for patients with moderate-to-severe atopic dermatitis.

Background: Studies on the impact of comorbidities on treatment responses in severe eosinophilic asthma (SEA) are limited. This study was a real-world investigation into how the presence or absence of nasal polyps (NP) and sensitivity to aeroallergens influence the outcomes of mepolizumab therapy. Methods: In this retrospective study, data obtained from patients with SEA and who received at least 6 months of mepolizumab treatment were analyzed. The patients were initially divided into two groups based on the presence of NPs. Within these two groups, the patients were further categorized into subgroups according to the presence of aeroallergen sensitivity (AE). Asthma-related outcomes in the resulting four groups were evaluated both before mepolizumab treatment and during the follow-up period. Results: Among the 36 patients with NPs, 14 (38.8%) had AE (NP+AE+), whereas 22 (61.2%) did not (NP+AE-). Of the 35 patients without NPs, 17 (48.5%) had AE (NP-AE+), and 18 (51.5%) did not (NP-AE-). The presence of NPs, independent of AE, was significantly associated with an increase in asthma exacerbations and oral corticosteroid (OCS) use before treatment (p < 0.001). In the NP+AE+ group, the baseline Asthma Control Test (ACT) score was lower, and the number of hospitalizations was significantly higher (p < 0.001). After mepolizumab treatment, all four groups showed significant reductions in asthma-related exacerbations, hospitalizations, and OCS use. Furthermore, ACT scores and pulmonary function test parameters significantly improved. There were limited differences in asthma improvements among the groups, with the NP+AE+ group showing a significant increase in ACT scores and a reduction in hospitalizations compared with the other groups (p < 0.001). Conclusion: Mepolizumab significantly reduced asthma exacerbations, hospitalizations, and OCS use in the patients with SEA with four different phenotypes. Analysis of these findings suggests that mepolizumab provides real-world benefits regardless of the presence or absence of NPs and AE.

Perioperative anaphylaxis is a serious entity with high morbidity and mortality. Perioperative anaphylaxis can be caused by any of the multitude of medications and substances used in anesthesia and surgery, and the most common causes include neuromuscular blocking agents, antibiotics, antiseptics, latex, and dyes. The differential diagnosis of perioperative anaphylaxis is wide from both an immunologic and a nonimmunologic standpoint. The majority of the intraoperative anaphylaxis reactions are thought to be immunoglobulin E (IgE) mediated; however, other primary non-IgE-mediated mechanisms can also be present. Clinical manifestations can vary from mild cutaneous exanthema to cardiac arrest. Tryptase can be helpful in identifying perioperative anaphylaxis. In this article, we present the case of a 75-year-old man who had a cardiac arrest without skin symptoms perioperatively during coronary artery bypass surgery. We describe the presentation, strategic evaluation, and subsequent management with recommendations for future surgery based on his evaluation and the identified culprit. Subsequent surgery was later completed. Understanding the clinical presentation, key components of testing, and recommendations for future management of perioperative anaphylaxis are invaluable skills that the allergist can provide for the patient and the anesthesia and surgery teams.

Background: Despite the use of long-term prophylaxis (LTP) for hereditary angioedema (HAE), the risk of having an attack remains and patients with HAE and on LTP may still experience attacks that can be life threatening. However, the behavioral patterns and perspectives surrounding HAE attack management by patients on LTP are not fully understood. Objective: This survey aimed to better understand and compare the behavioral patterns and perspectives, including attitudes and perceptions associated with on-demand treatment among patients on LTP versus those using on-demand therapy only. Methods: People living with HAE were recruited by the US Hereditary Angioedema Association to complete a 20-minute online survey between September 6 and October 19, 2022. Participants were stratified by treatment (50% using LTP [+on-demand therapy], 50% on-demand therapy only). Results: Respondents included 107 patients with HAE (mean age, 41 years [range, 16-83 years]). Patients using LTP reported treating a mean ± standard deviation 84.8% ± 23.8% of their HAE attacks compared with a mean ± standard deviation 75.6% ± 27.5% for patients with on-demand only treatment. Similar percentages of patients on LTP versus patients on-demand only reported always carrying on-demand treatment when away from home (35% versus 38%) and modifying their daily lives to minimize the occurrence of HAE attacks, which included avoiding potential triggers (42.9% versus 45.5%). Conclusion: Although patients on LTP treat a higher percentage of their attacks compared with patients with on-demand only treatment, both groups reported similar behaviors in terms of carrying on-demand treatment when away from home and modifying their daily lives to minimize the occurrence of HAE attacks. These findings highlight the importance of understanding patient perspectives and behaviors in the management of HAE.

Background: Atopic dermatitis (AD), a common chronic inflammatory skin disorder is characterized by a complex pathology with skin-barrier abnormalities, immune dysregulation, and microbial dysbiosis. Patients' quality of life is often negatively impacted by persistent pruritus, sleep disturbance, and recurrent skin infections. In addition, patients may have comorbid atopic as well as nonatopic diseases. Objective: The objective was to help clinicians better manage AD by using new therapies and new indications, including a topical (Janus kinase [JAK]) inhibitor as well as monoclonal antibodies and oral JAK inhibitors, have been approved for AD. Methods: This review presents highlights from the American College of Allergy, Asthma and Immunology AD Yardstick Update, which incorporates Expert Commentary, and from the Joint Task Force (JTF) AD 2023 Guidelines that use Grading of Recommendations, Assessment, Development, and Evaluation methodology. Results: Practical pearls from the AD Yardstick Update Expert Commentary are presented, along with results from systematic reviews and meta-analyses that addressed specific recommendations on the role of (1) dilute bleach baths, (2) dietary avoidance and/or elimination diets, (3) allergen immunotherapy, (4) topical treatments, and (5) systemic treatments, informing the JTF 2023 AD Guidelines. These guidelines are noteworthy for addressing patient values and preferences. Conclusion: The AD Yardstick Update Expert Commentary and JTF 2023 AD Guidelines provide timely, practical, and trustworthy information to help clinicians manage patients with AD.

Since its first description more than a decade ago, our understanding of the clinical impact of hereditary alpha-tryptasemia has continued to evolve. First considered to be a genetic disorder with a subset of patients having a syndromic presentation composed of connective tissue abnormalities, symptoms of autonomic dysfunction, and findings of mast cell activation, we now know that hereditary alpha-tryptasemia is a common genetic trait and modifier of mast cell-mediated reactions. More recent studies have shown some previously held associations with congenital hypermobility and postural orthostatic tachycardia syndrome (POTS) to be lacking, and illuminated previously unappreciated associations with clonal and nonclonal mast cell disorders. With the discovery of heterotetrameric tryptases and demonstration of their unique functional activities, the importance of tryptase gene composition in general has begun to take focus. Hereditary alpha-tryptasemia exists at the end of a spectrum of alpha-tryptase expression and as a natural overexpression model of this protein, brought to the fore the potential of tryptase genotyping as a genetic biomarker for anaphylaxis severity. These data and future studies hold the promise of enhancing our understanding of the role that tryptases play in health and disease.